Hair Restoration Blog

Alopecia areata (AA) is a type of local hair loss due to autoimmune reaction of the patient’s body against hair follicles.  Alopecia Areata generally presents as circular coin shape hair loss lesions, but it can progress to involve larger areas of the scalp (Alopecia Capitis) or even the entire body (Alopecia Universalis).

Several treatment options are recommended for inducing hair growth for treatment of alopecia areata. Some patients may recover spontaneously over a period of time; because of this patients should be evaluated and selected carefully.  It is important that the options to forgo treatment are reviewed with the patients, as well as discussing the high failure rate of all the various options available.

Most people who have hair loss on the hair line prefer to treat this condition more aggressively with a variety of medications.  The chance of spontaneous recovery appears to be more in patients who have smaller and fewer hair loss paths.

• Topical Steroids

Topical steroids for treatment of AA has been widely used with little evidence of success.  They are easy to use and more affordable to many patients. However, the current lack of evidentiary success does not make this a valuable recommendation for patients.

• Local Injection of Steroids

Infiltration of long acting corticosteroids into the AA lesions has been studied with some degree of success.  Patients with smaller lesions of alopecia areata may respond better to local steroid injections.

This type of local injections of steroids is most desirable for limited lesions of cosmetically sensitive areas like hair lines and eyebrows.  The most common used medication is Triamcinolone acetonide (5-10 mg/mL).

• Systemic Steroids

Systemic treatment with steroids may stimulate hair regrowth in a limited number of patients.   Continued use of steroids is generally needed in most of these patients to maintain the level of hair growth.  Pros and cons of long term use of steroids should be discussed with these patients before initiating systemic steroid therapy.

• Topical immunotherapy

Topical immunotherapy utilizing allergens has been studied and proven to have some success in patients. The protocol for contact immunotherapy using DPCP has been recommended. Continued use of DPCP is needed to keep the skin irritated for a long time.  The inflammation seems to be able to change the progress of immune reaction that causes hair loss in alopecia areata.

Treatment should be discontinued only after full regrowth is apparent.  This can take an indeterminate length of time, and during this period patients may have to tolerate inflammation of the skin.  A high rate of relapse after discontinuation of treatment makes this option less desirable for most hair specialists.

• Other treatments of alopecia areata

Other medical treatments such as phototherapy, photochemotherapy, minoxidil and dithranol  have shown limited improvements.  Finally patients with extensive stages of hair loss with no response to treatment options may use wigs or hair systems.  That is more desirable for many women with extensive hair loss due to alopecia areata that are having zero to minimal response from any other treatments.

Q:

My daughter, aged 20, has recently become the victim of AU.  I am a doctor myself and understand the etiology.I would like to know if there are any reports on therapy using IV methylprednisolone and endoxon.

I would also like to know if there is any relation of AU WITH ERYTHROCYTOPENIA as my daughter is having Hb around 9-10% RBC COUNT OF 3.3 to 3.6 million.

A:

Yes, several studies have concluded which indicate use of high dose steroids as pulse therapy to improve the outcome of Alopecia Areata (AA) and its more severe forms Alopecia Universalis (AU) if used early on in the process of the disease.

The results of a study  performed on 66 people who suffered from severe alopecia areata were published in 2003 to show a positive response in patients; with Alopecia Universalis results were favorable in about 80% of patients.  There has been a high rate of relapse among the treated patients of the study, but a few have stayed clear of the disease following their first treatment. More information on this study can be found here: http://www.ncbi.nlm.nih.gov/pubmed/12746668

This study provides the best indication of pulse methylprednisolone therapy: first recent episode of extensive plurifocal alopecia areata. These results are less convincing in patients with a long term history of the disease or other advanced forms of alopecia areata.

There have been strong links to support autoimmune etiology for Alopecia Areata and its more severe form of Alopecia Universalis.  The disease has also been seen in other diseases that are autoimmune in nature.  It is not clear, however, why alopecia areata and other autoimmune diseases might be present concurrently in the same person.

There are some suggestions regarding the possible triggers for autoimmune attacks (i.e.- viruses, infection, medicines, sunlight, or other environmental factors) that can prompt the immune system in a extraordinary method to attack the body’s own tissues. Pernicious anemia, a serious form of anemia, is typically caused by autoimmune processes and has often been present in patients with Alopecia Areata or Alopecia Universalis.

I believe a thorough evaluation of your daughter for the causes of her erythrocytopecia is the first priority at this point.  Your daughter may have a systemic condition that aggravated both her skin and hematologic conditions which should be investigated by a qualified dermotologist in your area.

To see more information on hair loss caused by autoimmune and other diseases, please visit our Other Types of Hair Loss page.

Q:

Hello Doctor,

This is XXXX from India.
My sister is suffering from Alopecia Areata for last 11 years. We tried treating her disease with every thing we knew (Alopathy/ Homeopathy/Ayurved) but it’s of no use. May be because we didn’t have proper guidance. It will be great if you can kindly guide us how should we move forward to treat her.

Thank you in advance.

Regards,
XXXX

A:

Alopeica areata (AA) is an autoimmune condition of skin.  AA usually does not need any medical intervention and the lesions improve spontaneously.  However, at times the balding spots might be very difficult to treat.  Although there is minimal evidence that injections of steroids can change the process of this disease, many physicians treat the balding AA lesions with intramural injections of long acting steroids.  Topical medications including minoxidil may also be used in some cases.  There are several current studies being conducted on the use of irritating agents to possibly change the inflammatory process of the skin.  Use of irritating agents are still not in the main stream treatments of Alopecia Areata.

Hair transplantation is definitely not one of the options at this time, because newly transplanted hair may be going through the same balding process with the same mechanism.  My best recommendation is to find a qualified dermatologist in your area and continue with him or her through future treatments.  You must be patient in circumstances such as these and try to understand that a quick recovery may not be achieved in some patients.

Q:

Hi Doc! How are you?

I have question regarding my hair loss problem. I’ve noticed it just 3 weeks back. As I’ve been reading your infomercial regarding the causes of hair loss. I think I am categorizing my problem to Alopecia Areata where I have one circled affected areas on the right of my front hairline & 2 at the right side at the back of my head. Before that it was small and now it is becoming bigger day by day.

Hope you could help me to find a solution of my problem. Thanks a lot! Hope to hear from you soon!!!
More power!!!

A:

Alopecia areata (AA) in its typical form is easily distinguished from typical patterned male and female hair loss.  Obviously, you need to be examined by a hair specialist or a dermatologist to confirm the diagnosis.  Alopecia areata generally present itself with a patchy or circular (coin shaped) balding spot and could be seen in almost anywhere in the skin.  The lesions are confined to their primary spots with no sign of hair loss in neighboring areas.  Some authorities have recommended steroid injections to facilitate the improvement of the lesions.  However, spontaneous recovery is seen in most patients with no interventions.

In contrast, hair loss pattern in male or female patterned hair loss is more widespread with the hair miniaturization (thinning) advancing to the neighboring areas.  Hair transplantation is not indicated in alopecia areata while it could be the only permanent solution in most cases of patterned baldness.

Q:

Hello,

Have been diagnosed with Alopecia Universalis, not a problem from a cosmetic point of view as I’m over 65, comfortable with myself as a person, and have a positive outlook on life and a strong faith.  The only thing that is bugging me is my finger and toenails.  The pitting and destruction of the nail bed is a problem.  Wondered what the best thing I can do at this point.  I have had the nails covered with an acrylic at a nail studio and for the most part, this seems to work until they get long and snap off.  Should I be taking a special vitamin such as Biotin or Zinc?
Thanks,

A:

This is a good question and I personally could not find your answer myself anywhere. I discussed it with some of my dermatologist colleagues (when it comes to nails, they are more involved with this condition and have probably seen or treated more similar cases of nail changes with Alopecia Areata or Alopecia Universalis.

Here are two of the answers I received from other doctors who see this condition more than me:

1.    Um…I see a fair number of patients with significant deformities of their nails including clubbing, rippled nails, flaking, dents in the names and the distal phalanges with granulation tissue and fullness all starting after they started getting those acrylic manicures. They are pretty rough and they often get damaged nail beds.

2.    Hey Parsa, Unfortunately there isn’t much you can do for the nail pitting that you see with Alopecia Areata or Alopecia Universalis. You can cover it with acrylics – that would be fine, but would damage the nail further over time. Nail polish and manicuring would be preferred treatments. Using Biotin would be fine to promote healthier nails but wouldn’t get rid of the underlying problem. You can also try potent topical steroids to see if that would make a difference.  Hope this helps.

Q:

Dear Dr. Mohebi,

Thank you for taking the time to see me on Saturday! Your correspondence providing a summary of our discussion was very comprehensive and is much appreciated!

Since our meeting on Saturday, I have done some research and would like to trouble you with a few more questions:

1) Is Alopecia the correct term to describe my hair loss pattern?

2) Would you consider cortizon shot treatment for me?

3) Would you consider laser therapy?

4) If I were to use monoxidil, does it have to be 2% or a higher percentage would yield more and faster hair growth?

5) you recommended a complete medical evaluation, could you please recommend someone that you trust?

I wish to thank you again for all your time and patience!

Best regards,

A:

Hi,

Here are your answers in the order you asked:

1) Is Alopecia the correct term to describe my hair loss pattern?

Alopecia is a general term that means hair loss. We have many different patterns of hair loss or alopecia, like male pattern or female patterned alopecia or alopecia cicatricial. Your pattern is similar to a male pattern because you lost your hair on the frontal area while you kept your hair on the donor area intact, which is why you might be a good candidate for a hair transplant procedure considering that your medical evaluation is negative for any medically treatable cause of hair loss.

2) Would you consider cortizon shot treatment for me?

No, steroid shots are sometimes used for Alopecia Areata (AA), which is an autoimmune disorder. Alopeica Areata is a hair loss condition with patchy hair loss spots. Your condition does not seem to be Alopecia Areata.

3) Would you consider laser therapy?

I do not recommend laser therapy for hair loss in the form of laser comb or laser machines because of the lack of solid medical evidence that support their effectiveness at this time.

4) If I were to use Monoxidil, does it have to be 2% or a higher percentage would yield more and faster hair growth?

You can start with 2% and then you need to be re-evaluated in six to 12 months and a treatment plan might need to be adjusted at that time.

5) you recommended a complete medical evaluation, could you please recommend someone that you trust?

Any good internist or endocrinologist could follow through with the lab works that you need.  Our letter includes the list of medical conditions that should be considered and lab works to rule out those women like you who have hair loss. You can share my letter with any good internist or endocrinologist and he or she should be able to follow through with your lab result and treat any treatable conditions that could possibly be found.

Have a great day,